“Sunshine is the best disinfectant,” the old saw goes.
Some hospital officials might disagree. While they are big believers in peroxide, alcohol, and ammonium disinfectants, some get very squeamish when sunshine is used to disinfect systemic germs in the medical sector.
It’s completely understandable that the hospitals featured on today’s front page of the St. Paul Pioneer Press are uncomfortable. It can’t be much fun to have the federal government telling the world how you are doing when it comes to death and readmission rates for three common ailments.
But these disclosures are as healing as the disclosures made by patients in exam rooms.
When performance and medical error data move from dusty manila folders to the front page of the paper, poor performing hospitals get external and internal pressure to fix languishing problems. Strong performing hospitals get due credit and subsequent referrals to reward the fruits of their labors. And with successes and failures out in the open, all hospitals are better able to learn from each other.
Moreover, such disclosures give referring physicians and patients the ability to shop based on something more meaningful than hospitals’ marketing chotskies, ads about new machines, and opulent lobbies.
If we’re going to have a free market health care model, and it looks like we are, consumers need better access to better information. Markets only work well when patients are informed enough to vote with their feet, or walkers. But health care consumers have been blindly stumbling around in the dark for too long. Our stumbling is a big reason the markets haven’t been working well.
To be sure, these kinds of disclosures aren’t perfect. For instance, some hospitals take on the most challenging patients. It’s more difficult for these hospitals to achieve excellent outcomes than it is for hospitals who keep the less challenging patients and refer the most challenging patients elsewhere.
But disclosures lead to better referring physician and consumer understanding of these acuity-related dilemmas, and some information is better than no information whatsoever.
The disclosures shouldn’t end with outcomes and error data. Physicians who receive tax dollars should be required to disclose their financial stakes in medical companies. That information should be readily available to patients. Patients and regulators need to be able to ask, “Did that physician order that test or device because there is a proven, science-based need, or because she is profiting from it?” Most physicians will have a good answer to the question, but the question needs to be asked. As the 5th Dimension opined, ‘Let the sun shine in.”
Likewise, caregivers who want to accept Medicare, Medicaid or other public funds, should have their salaries disclosed. These talented and well-educated people deserve to be very well-compensated. They’ve got massive medical school debts and medical malpractice insurance bills. But patients have a hard time judging the merits of physicians’ claims that federal reimbursements are causing financial hardships. As taxpayers footing huge payments to physicians, we deserve better information about physicians’ relative financial position and subsequent reimbursement needs.
So, please, keep the peroxides, alcohols and ammonias flowing in Minnesota’s hospitals and clinics. But more and better communications is another disinfectant we need to add to the mix.